Biomedical subjects

C A Hartwig

Publications and source records attributed to C A Hartwig.

12 recordsLinked to original sources

PubMed1995

Selective right ventricular angiography in apparently idiopathic ventricular fibrillation.

The definition of underlying heart disease in apparently idiopathic ventricular fibrillation seems to be important in regard to prognosis and choice of therapy. From October 1989, until August 1993, cardiac arrest due to the documented ventricular fibrillation occurred in eight consecutive patients with normal results on clinical examination, normal echocardiography, and normal or apparently nonspecific electrocardiogram (ECG) findings. Complete invasive investigations, including selective right ventricular angiography, were done; regional hypokinesia and segmental bulging of the right ventricle were found in seven patients (88%). Arrhythmogenic right ventricular dysplasia was suspected in these patients, although endomyocardial biopsy was not performed. After the finding of localized right precordial QRS prolongation of more than 110 ms in November 1993 in five patients, a retrospective, a more precise approach to QRS duration in standard ECG supported this diagnosis. Selective right ventricular angiography is of great help in identifying underlying heart disease in patients with apparently idiopathic ventricular fibrillation, and confirms ECG findings.

Adolescent↗

PubMed1994

[Incidence and significance of morphologic and morphometric variants in selective right ventricular angiography in diagnosis of arrhythmogenic right ventricular disease].

BACKGROUND: In arrhythmogenic right ventricular disease it is difficult to find an imaging technique not only to suppose but to diagnose this disease. PATIENTS AND METHOD: In order to assess the value of selective right ventricular angiography in 104 patients with arrhythmogenic right ventricular disease (n = 53), WPW-syndrome (n = 2), sarcoidosis (n = 1), atrial septum defect (n = 8), dilative cardiomyopathy (n = 8), mitral valve disease (n = 17) and normal patterns (n = 15) right ventricular angiography was performed in biplane 30 degrees RAO/60 degrees LAO projection. Quantitative criteria such as RVEDVi, RVEF, regional wall motion in infundibular, inferior, apical and anterior segments and qualitative criteria such as deep horizontal fissures in trabecular hypertrophy, "pile d'assiettes" phenomenon and enddiastolic bulges with loss of trabecular structure were analysed. RESULTS: After extensice statistical analysis enddiastolic bulges with loss of trabecular structure and in less circumstance segmental contraction impairment of the right ventricle are the most valuable angiographic signs in order to diagnose ARVD. CONCLUSION: The best definition of arrhythmogenic right ventricular disease is obtained by extensive angiographic analysis with measurement of oxygen saturation and pressure curves in different positions, coronary angiography and biventricular angiography in order to distinguish between some in regard to right ventricular involvement similar cardiac entities.

Adult↗

PubMed1992

Risk assessment in nonischemic ventricular arrhythmia by left and right ventriculography.

Ventricular fibrillation and sudden death are rare phenomena in nonischemic ventricular arrhythmia, particularly in arrhythmogenic right ventricular cardiomyopathy. In most instances electrophysiologic studies help to assess the risk of sudden death, but sometimes programmed ventricular stimulation is unsuccessful. Among 48 patients with ventricular fibrillation (n = 9) and sustained (n = 25) and nonsustained (n = 19) ventricular tachycardia, invasive and noninvasive diagnostic tests (coronary angiography, biventricular angiography, programmed ventricular stimulation, and echocardiography) were performed to obtain more information about the underlying heart disease. In 43 patients (90%) arrhythmogenic right ventricular cardiomyopathy was diagnosed with segmental hypokinesia (n = 31) and diffuse hypokinesia (n = 12) of the right ventricle. In patients with documented ventricular fibrillation, the right ventricular ejection fraction was lower (30.8% vs 47.8% and 45.9%, respectively) and multisegmental contraction impairment of the right ventricle was significantly more frequent (p less than 0.001). Additional left ventricular abnormalities and right ventricular dilatation were not significant parameters for identifying high-risk patients. In addition to programmed ventricular stimulation, quantitative analysis of the results of right and left ventricular angiography contributes to risk assessment in patients with nonischemic ventricular arrhythmia.

Adult↗

PubMed1989

Natural history of single vessel disease. Risk of sudden coronary death in relation to coronary anatomy and arrhythmia profile.

214 patients with single vessel disease were followed-up for 1-78 months (mean 48 months). Incidence of sudden death was studied in relation to coronary artery lesions, left ventricular wall motion and ventricular arrhythmias found during ambulatory ECG recording. Incidence of sudden death was 11% (16 of 144) in patients with lesions of the left anterior descending branch (LAD), 8% (4 of 55) in lesions of the right (RCA) and 7% (1 of 15) in those with lesions of the left circumflex (LCX) coronary artery. Coronary artery occlusion was associated with a significantly higher incidence of sudden death (15%, 18 of 123) than high-grade stenosis (3%, 3 of 91) (P less than 0.05). The risk of sudden death increased in patients with complex arrhythmias and occluded LAD or RCA (8 of 38, 21%; 2 of 12, 18%) compared with patients without complex arrhythmias (5 of 34, 15%; 1 of 18, 6%). One patient with LCX occlusion died suddenly. Our data show that the incidence of sudden death in relatively low in patients with single vessel disease. However, there is a high risk of sudden death in patients with LAD or RCA occlusion associated with akinetic left ventricular areas and complex arrhythmias.

Adult↗

PubMed1989

[High-dose single administration of isosorbide dinitrate: effect on diurnal distribution of transitory myocardial ischemia in patients with stable angina pectoris].

We studied the effect of a monotherapy of isosorbiddinitrate on symptomatic and asymptomatic ischemic episodes in 15 ambulatory patients with chronic stable angina pectoris, positive exercise test, and coronary stenosis greater than 70%. Transient ST-segment depression (greater than 0.1 mV for at least 1 min) was documented by 48-h Holter monitoring during a control period without anti-ischemic therapy and at the end of 14 days of treatment with 120 mg o.d. isosorbiddinitrate slow-release. In the control period, 68 asymptomatic and 28 symptomatic ischemic episodes were detected; most of the episodes occurred in the morning between 6.00h and 12.00h (41 episodes) and in the afternoon between 12.00h and 18.00h (36 episodes). Under anti-ischemic therapy the number of episodes and the total duration of ischemia was reduced by 46% and 53%, respectively (p less than 0.01). The anti-ischemic effect was most evident during the morning and the afternoon; the ischemic episodes during the evening and the night were not significantly diminished. It is concluded that in patients with stable angina pectoris a single high-dose of isosorbiddinitrate significantly reduces the number and duration of transient ischemic episodes during daily life.

Aged↗

PubMed1989

[Simulated tachyarrhythmia. A case report].

In this case report, the hospitalization of a 34-year-old woman with a history of heart disease is described. Arrhythmias and precordial chest pain led to her admission to the coronary care unit. Different therapeutic trials failed. Finally it became obvious that all tachycardias documented by the arrhythmia monitoring system were artifacts, produced by manipulation at the ECG electrodes. After disclosure and confrontation, a psychic misdevelopment in combination with an abuse of analgetics was found.

Adult↗

PubMed1988

[Incidence of sudden cardiac death in patients with 2-vessel coronary disease in relation to anatomy and rhythm profile].

102 patients with angiographically documented double vessel coronary artery disease were followed for 1-83 months (mean: 42 months). Incidence of sudden death was studied in relation to location and severity of coronary artery lesions, left ventricular wall motion and ventricular arrhythmias found during long-term ECG monitoring. The incidence of sudden death was 30.5% (18/59 cases) in patients with lesions of the left anterior descending branch (LAD) and the right coronary artery (RCA) (Group GI), 26.1% (6/23 cases) in patients with lesions of the LAD and the left circumflex coronary artery (LCX) (Group G II) and 10.0% (2/20 cases) in patients with lesions of the RCA and the LCX (Group G III) (p less than 0.05). The incidence of isolated ventricular beats and complex arrhythmias was significantly higher in patients who died suddenly in both Group I and Group II compared to Group III (p less than 0.05). Our data show that in patients with double vessel coronary artery disease there is an increased risk of sudden death if the LAD is involved, particularly in the presence of complex arrhythmias.

Adult↗

PubMed1988

[Dose-dependent anti-arrhythmia effect of retard metoprolol in coronary disease patients with ventricular arrhythmia].

The antiarrhythmic efficacy of a slow-release form of metoprolol was studied in 13 male coronary patients, mean age 47 years (39-59 years) with frequent and complex ventricular arrhythmias (couplets, salvos). The prospective, single-blind trial was based on 24 h Holter monitoring. In each case, the extent of coronary heart disease and the presence of old myocardial infarction was documented by coronary angiography. Initial treatment with placebo was followed by active treatment with 200 and 400 mg metoprolol per day, respectively, and placebo again during one week each. Thereafter, 200 mg metoprolol/24 h were administered over a period of one month. At the end of each treatment period, metoprolol plasma levels were determined simultaneously with the assessment of cardiac arrhythmias by Holter monitoring. Under a daily dose of 400 mg metoprolol, plasma levels increased from 235 +/- 326 (under 200 mg) to 841 +/- 613 mumol/l (p less than 0.001), and mean heart rate decreased from 75 to 63 bpm (p less than 0.001), the average number of ventricular extrasystoles decreased from 1,722 to 480/24 h (p less than 0.05) and the number of couplets from 38 to 7/24 h (p less than 0.05) when compared to the placebo period. After one month's treatment with 200 mg metoprolol per day, a significant reduction in heart rate from 75 to 67 bpm was observed (p less than 0.05); however, antiarrhythmic efficacy with regard to the number of premature ventricular contractions and couplets was insignificant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

[Sudden cardiac death and arrhythmia profile in patients with single-vessel coronary disease].

214 patients with single vessel disease (high grade stenosis greater than or equal to 75% or occlusion of the LAD, RCA or LCX) were followed for 1-78 months, average 51 months. Incidence of sudden death was studied in relation to coronary artery lesions, left ventricular wall motion and ventricular arrhythmias found during ambulatory ECG monitoring at the time of angiography. Incidence of sudden death was 11.1% (16/144) in LAD, 7.3% (4/55) in RCA and 6.7% (1/15) in LCX lesions. Coronary artery occlusion was associated with a significantly higher incidence of sudden death (14.6%, 18/123) than high-grade stenosis (3.3%, 3/91) (p less than 0.05). The risk of sudden death increased markedly in patients with complex arrhythmias and an occluded LAD or RCA (21.0%, 8/38; 18.2%, 2/11) compared to patients without complex arrhythmias (14.7%, 5/34; 5.5%, 1/18) (p = ns). Only one patient (1/15, 6.7%) with an isolated LCX lesion died suddenly. Our data show that the incidence of sudden death over 51 months is relatively low in patients with single vessel disease. However, LAD occlusion or RCA lesion with akinetic left ventricular areas and complex arrhythmias are independent predictors of sudden death.

Adult↗

PubMed1988

[Value of stress and long-term ECG in the diagnosis of silent myocardial ischemia in patients with coronary heart disease].

Symptomatic and asymptomatic myocardial ischemia during exercise testing and during daily activities (ST-segment analysis on 24-h Holter ECG) was studied in 109 patients with stable angina pectoris and proven coronary artery disease (coronary stenoses greater than 70%) (group I) and in 20 patients with angiographically normal coronary arteries or minimal changes (group II). During exercise testing, 94/109 (86.2%) group I patients and 6/20 (30%) group II patients showed ST-segment depression greater than or equal to 0.1 mV. During Holter ECG, transient ST-segment depression (greater than or equal to 0.1 mV; greater than or equal to 1 min) was observed in 76/109 (69.7%) group I patients and in 5/20 (25%) group II patients; all patients with positive Holter ECG also had a positive exercise tests result. Heart rate and exercise duration at the onset of ischemia during stress testing were useful parameters to estimate the incidence of ischemic episodes during Holter ECG. Patients with asymptomatic positive exercise tests showed a significantly higher percentage of asymptomatic ischemic episodes during Holter ECG than patients with a symptomatic positive exercise test (89% vs. 68% asymptomatic ischemic episodes; p less than 0.001). Therefore, in patients with coronary artery disease and stable angina pectoris, the exercise test provides information also about the activity of ischemic heart disease during daily activities.

Adult↗

PubMed1987

[ST segment analysis in 24-hour long-term ECG in patients with stable angina pectoris and angiographically detected coronary sclerosis].

ST-segment analysis on 24-hour Holter ECG was performed in 64 patients with angiographically proven coronary artery disease, a positive exercise test and chronic stable angina. During 125 days of recording, 494 episodes of transient ST-segment depression were observed, at an average of 4.0 +/- 3.7 episodes (1-13 episodes, median: 3 episodes) per day. The duration of ST depression per episode was 13.2 +/- 14.4 min (1-90 min; median: 8 min). No episodes of ST-elevation were observed. Only 27 (5.5%) ischemic episodes occurred during the night, between midnight and 6:00 a.m., but they were frequently observed during the morning hours between 7:00 and 12:00 a.m. Nearly all episodes of ischemia were preceded by an increase in heart rate. However, heart rate at the onset of significant ST-segment depression was significantly lower during Holter monitoring than during exercise test (p less than 0.001); this indicates that factors additional to the increase in myocardial demand might be relevant for transient myocardial ischemia during daily life. 382 of the 494 episodes (77.3%) of ischemia were asymptomatic; heart rate at the onset of ST-segment depression was similar in symptomatic and asymptomatic episodes; however, in asymptomatic episodes, maximal heart rate was significantly lower (p less than 0.001) and the duration of the episodes significantly longer (p less than 0.001). The percentage of asymptomatic episodes was very high in patients with one-vessel disease, whereas the duration and amount of ST-segment depression, as well as heart rate, at the onset of ischemia, were not dependent on the extent of coronary artery disease.

Aged↗

PubMed1985

[Arrhythmia behavior and sudden heart death in isolated stenoses or obstructions of the anterior interventricular branch].

The incidence and pattern of ventricular arrhythmias recorded with 24 h ambulatory monitoring were studied in 144 patients with angiographically documented stenoses (greater than or equal to 75%) or occlusions of the left anterior descending coronary artery (LAD) and were related to left ventricular wall motion abnormalities. Ambulatory monitoring was performed at the time of coronary angiography and mean follow-up ranged from less than 1 to 5.4 with a mean of 3.3 years. The incidence of sudden cardiac death (within 1 h after onset of symptoms) was significantly higher in patients with LAD occlusion than in patients with LAD obstructions (14/79, 17.7% versus 2/65, 3.1%); (p less than 0.05). One hundred and twenty-two patients had anterior myocardial infarctions documented with ECG and LV-angiograms. The incidence and size of infarctions were comparable in patients with LAD stenoses and LAD occlusions. There was no difference in wall motion abnormalities, LV end-diastolic pressure (LVEDP) and ejection fraction in both groups. The majority of patients in both groups showed complex ventricular arrhythmias of Lown classification IV during Holter monitoring. The incidence of sudden cardiac death in patients with ventricular arrhythmias of Lown class IV was significantly higher in patients with LAD occlusions than in patients with LAD stenoses (9/40, 22.5% versus 1/31, 3.2%); (p less than 0.05). Quantitative evaluation of the arrhythmias showed that there was no difference between patients with LAD occlusions and LAD stenoses so far as single PVC's is concerned, yet complex ventricular arrhythmias (pairs and/or salvos) were found significantly more often in patients with LAD occlusions than with LAD stenoses (means 9.8 versus 6.3); (p less than 0.05). We conclude therefore that complete occlusion of the LAD is accompanied by more complex ventricular arrhythmias and bears a higher risk for sudden cardiac death than mere LAD stenoses although both groups of patients have the same left ventricular wall motion abnormalities.

Adult↗